This inspection took place on 6 April 2016 and was unannounced. At the last inspection, the service was rated as ‘Good' but we asked the provider to make improvements to ensure people living with dementia were fully supported to enjoy their meals. At this inspection, we found the required improvements had been made.

Horse Fair Care Home provides accommodation and or personal care for up to 72 people, Elmore suite on the ground floor and Lea Hall suite on the first floor. On the day of our inspection, 56 people were living in the home, 29 in Elmore, and 27 in Lea Hall, some of whom were living with dementia.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. People’s care was regularly reviewed to ensure it continued to meet their needs. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Where people were restricted of their liberty in their best interests, for example to keep them safe, this was authorised in accordance with the legal requirements.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People were supported and encouraged to eat and drink enough to maintain a healthy diet. People received their medicines as prescribed and were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and support that met their individual needs. The provider offered people a programme of recreational and leisure opportunities and encouraged people to follow their individual interests. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

There was an open and inclusive atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. People knew how to make a complaint and were confident this would be fully investigated and action taken if necessary.

Staff felt supported by the provider and management team and were clear about their roles and responsibilities. Arrangements were in place to assess, monitor and improve the quality and safety of the service people received.

This inspection took place on the 4 November 2014 and was unannounced.

Horse Fair Care home provides accommodation and personal care to up to 72 people, some of whom may be living with dementia.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was not available on the day of the inspection.

At our previous inspection in May 2014 we found the provider had insufficient staff to keep people safe. At this inspection we found that improvements had been made. New staff had been recruited and there was sufficient staff to meet the individual needs of people who used the service.

People were safe. Staff knew what constituted abuse and reported it appropriately through the provider’s and local authority safeguarding procedures.

Risk assessments were in place which supported people to remain safe whilst remaining as independent as they were able to be.

Recruitment processes were robust and ensured that prospective staff were fit to work.

Medicines were stored and managed safely. People had their medication at the prescribed times.

Staff had received training and supervision to ensure they were effective in their roles. New staff had a period of induction to ensure they were competent.

The provider recognised the requirement to work within the guidelines of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). Referrals were in the process of being made for people who may have been restricted of their liberty.

People had a healthy choice of food. When people required more support to meet their nutritional needs, plans were put in place to monitor and ensure that people received adequate food and fluids, however people living with dementia would have benefited from having their individual needs assessed.

People’s health care needs were met. Records showed that people were supported to see a health care professional when they became unwell or their needs changed.

From our observations and talking to people who used the service, people were treated with dignity and respect. Interactions between staff and people were kind and compassionate.

People and their relatives were fully involved in their own care planning. Where able people had signed their own care plans.

Activities were on offer to support people to participate in their hobbies and interests

People knew how to complain if they were not happy with the service they received. Contact numbers for other support agencies were readily available in the living areas.

Resident, staff and relative meetings took place on a regular basis. Minutes were recorded and we saw examples of where action had been taken when suggestions had been made at the residents meetings.

Staff told us that they felt supported by the management. The registered manager had been absent for some time and the deputy manager was acting as manager. Staff told us that this had not affected the running of the home and they continued to deliver good quality care.

The provider kept us informed of any significant incidents and had systems in place to monitor the quality of care being delivered.

We visited Horse Fair Care home on a planned, unannounced inspection which meant the service did not know we were coming. We had received some information of concern about a number of unexplained injuries to people prior to our inspection and this formed part of the inspection planning process. We were supported throughout the inspection by a specialist advisor.

We are changing how we inspect services in the future and also making changes in how we report our findings. Below is a summary of our finding based on our observations, speaking to people who used the service, their relatives, the staff supporting them, specialist advice and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is it safe?

People who used the service and their relatives told us they felt safe at Horse Fair Care Home.

Staff had received safeguarding training and knew how to keep people who used the service safe from the risk of abuse.

We had concerns that there were insufficient staff to safely meet the needs of people who used the service. We have asked the service to make improvements in this area.

Is it effective?

Everyone had a care plan which informed staff how to meet people’s needs. Assessments included the needs for specialist equipment, mobility aids and dietary requirements.

People had access to a range of health professionals when they required them, some of which visited the home.

Is it caring?

Staff treated people with dignity and respect.

People who used the service told us they liked the carers at Horse Fair Care Home. One person told us: “I feel very fortunate to be here”.

Is the service responsive?

People were able to engage in meaningful activities if they chose to.

Regular reviews of people’s care took place and included people and their representatives.

If people’s needs changed the service sought the appropriate support from other agencies.

Is the service well led?

The service had a system to assure the quality service they provided. The way the service was run was regularly reviewed.

Staff told us they felt supported and had the training to fulfil their role effectively.

We carried out this inspection as part of our schedule of inspections to check on the care and welfare of people using this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

We spoke with the home manager, the deputy manager, two senior carers, four care staff, a housekeeper, a visiting district nurse, 12 people who lived in the home and four relatives.

We looked at how people were involved in their care and how privacy and dignity were maintained. One person told us: "I am very settled here. The staff are very respectful to me, I would soon say if they weren't".

We looked at how people were protected against the risk of receiving care or treatment that was inappropriate or unsafe. We looked at how care was assessed, planned and reviewed.

During the inspection we looked at the systems in place to manage medicines and how medicines were administered and stored in the home. We observed staff during a medication round.

We looked at the procedures that were in place to ensure that the right staff were employed in the home with suitable qualifications, skills and experience necessary to perform their role. One relative told us: "We are very impressed so far, it's a great relief to see her so settled. The staff are lovely".

We looked at the complaints procedure that was in place and how complaints and comments made by people using the service or their representative were handled.

In September 2012 we identified non-compliance in Outcome 14 relating to the behaviour of some of the staff working in the home. The staff had received appropriate training, however at times they were not following the training advice or the provider's policies and procedures.

At this visit we spoke with four staff and eight people that used the service. The staff we spoke with were knowledgeable and appeared compassionate when being observed. The people we spoke with were complimentary about the staff and the care home in general.

We visited the home on 21 September 2012 to check the progress of the previously set compliance actions. We identified that the compliance actions had been met.

We spoke with ten people who lived in the home and all but one were happy. One person told us they had looked for somewhere else to live but they had decided to stay. Another person told us, "I love it here, everyone is so friendly. The meals are very good too".

One relative told us, "They always seem to be doing something when we visit. The atmosphere in the home is quite lively. We are very happy with the care offered here. I have visited at meal times and the food looks and smells lovely".

Whist in the home we identified some staff practices which were unacceptable and a compliance action was set against regulation 23.

We visited Horse Fair Care Home on 10 July 2012 as part of our scheduled inspection plan. The visit was unannounced which meant the provider and the staff did not know we were coming.

We involve people who use services and family carers to help us improve the way we inspect and write our inspection reports. Because of their unique knowledge and experience of using health and care services, we have called them experts by experience (ExE). Our experts by experience are people of all ages, from diverse cultural backgrounds who have used a range of health and/or social care services.

We were accompanied by an ExE on this visit. The ExE took part in the inspection and talked to the people who used the care service. They looked at what happens around the home; observed how everyone got on together and what the home felt like. The ExE took some notes and wrote a report about what they had found. These details will be included in this inspection report.

Whilst on the visit we spoke with 12 people using the service, three visitors and eight staff. We looked at records of care, staff rotas, staff recruitment records and other documents. At the time of our visit there were 63 people living in the home, with two people in hospital.

Most of the people we spoke with on the general unit told us that they were comfortable living in the home and that they were able to maintain their own independence. People told us that the staff were friendly. People we spoke with on the dementia unit were not always able to tell us their views, in which case we spoke with relatives and staff.

One relative told us “I visit every other day and I find the staff very supportive of the people living in the home and their relatives. I find that the care is good and they do contact me if there is a problem. I sometimes worry about the door being closed and the ability of the staff to observe, but generally I feel people are safe here.”

One person told us “I am quite happy here, I feel safe and well looked after. The food is ok; I think it could look a bit more appetising at times. I know the manager is looking at the menu choices. I think the staff work very hard to make sure everyone is well cared for.”

We saw people were given a choice of activities they could take part in throughout the day. We saw that people were offered two choices of meals at lunch time.

We looked at six care plans and saw that the new manager had commenced a more person centred approach to the documentation.

We looked at the staff rotas and observed the staffing deployment on the day of the visit. We identified that some areas of the home were less well observed than others and a discussion took place with the manager regarding our observations.

The manager gained feedback from people that lived in the home and their relatives and next of kin. The home was continually monitored by the company to ensure that a good quality service was delivered.

We saw a comments and compliment book in the entrance of the care home and there were cards and thank you letters from satisfied relatives and friends. The home had no current complaints at the time of the visit. We saw a complaints procedure displayed in the home.

Comments received included “they really look after me well, I have no problems with the staff at all, they are all wonderful.” “The staff are always pleasant and polite”.

“We are well treated here, and we are asked by staff every day what would we like to eat”.

One person living at the home told us that she was happy with her care, and with the care staff that looked after her. She confirmed that the food at the home was good, and that she had access to fruit and snacks if she wanted them. She told us there were lots of activities organised, and that she tried to join in with these when she could. She told us how staff changed her position regularly, and were very polite and always caring.

Another person living at the home told us he was very pleased with the home, his room, and his care. He said staffs were really good, and that he sometimes had to wait for them to come, but that was not very often. He talked about the food at the home, and said it was "always nice", he also told us that "staff often asked him what he wanted to eat". He preferred to stay in his room sometimes, but was aware of the activities happening in the home. He said there was "always something going on", if he wanted it.